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With everything from stock rebounds to product recalls, 2010 has already been an eventful year for auto stocks. But with all of that chatter in the auto industry, it's sometimes difficult to tell which stocks you should add to your portfolio - and which you should avoid. Here's a rundown of a few of the car stocks with the best potential for the year.
IN PICTURES: 20 Tools For Building Up Your Portfolio
Investors have been wise to avoid the autos for a few years. A highly publicized bankruptcy for General Motors last year was the final nail in the auto industry's coffin, following a long record of slumping sales that was exacerbated by a seized-up credit market. And Toyota's recall troubles sent an equally chilling signal in 2010, reminding investors that while sales numbers had perked up, there were still critical risks in the industry.
But while troubled stocks were faltering, some of the auto industry was actually thriving. As surprising as it may seem, 2008 and 2009 provided some automotive companies the opportunity to clean house and regroup - only to post solid numbers in the early part of this year. And perhaps more surprisingly, one of the brightest stars in 2010 has been an American automaker.
Dealing with Domestic Automakers
The automotive industry in the U.S. has seen its share of trouble for the last couple of decades, plagued by intense competition from foreign marquees and serious consumer satisfaction shortfalls, Detroit's "big three" automakers - GM, Ford, and Chrysler - have seen their market capitalizations dwindle in the 2000s.
Both Chrysler and GM filed for bankruptcy in 2009, resulting in the end of the latter's trading on the NYSE (Chrysler was already a privately-owned company). But the company that remained unscathed was Ford.
Ford benefited from being the "best of the worst" but new direction could mean that Ford will see long-lasting operational advantages. The company is already doing a good job of proving its ability to produce quality vehicles (one of the reasons its Focus compact continues to be one of the top-selling cars in Europe). Ford's mainstream Focus and Taurus lines were redesigned to compete with highly economical Japanese offerings, and its 2011 Mustang has already left gear heads drooling: the new model offers significantly more horsepower than current iterations.
Shares have moved in kind, rallying more than 200% in the last 12 months. Although debt continues to be a problem for automakers, Ford's balance sheet is improving quickly and other auto bankruptcies should give the company extra bargaining power with unions. As Ford continues to trim its expenses and build cars that consumers will fawn over, the company should see margins improve in 2011.
Have Foreign Car Stocks Lost Their Luster?
Toyota's costly recalls have left a huge blemish on foreign automakers. Once thought to be beyond reproach from a quality, efficiency and ethical standpoint, revelations about the best-selling automaker dragging its heels on recall status continue to unfold.
And they continue to cast a shadow on the stock - dragging it double-digits below market averages year-to-date. (For more, see Recall Recoil: Will Toyota Recover?)
One of the biggest beneficiaries should be fellow Japanese rival Honda Motors, which enjoys one of the most value-retaining car fleets in the world right now. Honda's carving out a high-margin niche in the hybrid market, and it does so with relatively low labor input costs - but a strong yen could undercut profits given the U.S.'s positioning as the largest auto market in the world.
More interesting automobile plays are coming from the emerging market, where companies like India's Tata Motors and China's Geely Automotive are taking advantage of deflated equity prices to snatch up bargain-priced premium brands like Range Rover and Volvo.
While many of the best foreign automakers are difficult to invest in because they lack decent trading volume or ADR issues, their suppliers or U.S. dealers provide an easy point of access. Penske Automotive Group and China Automotive Systems are just two examples of back door foreign car plays.
Know the Cycle
Because the auto industry is largely cyclical, it's prone to boom and bust economics. Even so, with consumer credit and spending both on the upswing in 2010, there's ample opportunity to take advantage of the cream of the automotive crop. Here's to a clear road ahead this year for the auto industry. (To learn more, check out Analyzing Auto Stocks.)
Check out last week's business highlights in Water Cooler Finance: My iPad Beats Your Toyota.
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Investing Basics
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Forget Volkswagen, Should You Avoid its Suppliers?Volkswagen is getting all the headlines but there are other companies that will feel the pain.
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1 This is a pre-copy-editing, author-produced PDF of an article accepted for publication in Rheumatology (Oxford) following peer review. The definitive publisher-authenticated version Rheumatology (2013) doi: 10.1093/rheumatology/ket154 First published online: April 22, 2013 is available online at: http://rheumatology.oxfordjournals.org/content/early/2013/04/22/rheumatology.ket154.full?sid= 0c164de0-04ee-4f5b-b302-d1c51698d107. New classification criteria for gout: a framework for progress Nicola Dalbeth1, Jaap Fransen2, Tim L Jansen3, Tuhina Neogi4, H. Ralph Schumacher5, William J Taylor6, Steering Committee for the Gout Classification Criteria Project. 1. University of Auckland, Auckland, New Zealand 2. Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands 3. Department of Rheumatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands 4. Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston MA, USA 5. University of Pennsylvania and VA Medical Center, Philadelphia PA, USA 6. University of Otago, Wellington, New Zealand. Corresponding author: Assoc Prof Nicola Dalbeth, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland, New Zealand. Phone +64 9 3737999 x82568. Fax +64 9 3737677. Email: email@example.com. Word count: 2,211, Tables: 2, Figures: 1. Running title: Gout classification criteria
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2 Disclosures: The authors have no relevant financial disclosures.
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3 Abstract The definitive classification or diagnosis of gout normally relies upon the identification of monosodium urate (MSU) crystals in synovial fluid or from tophi. Where microscopic examination of synovial fluid is not available or is impractical, the best approach may differ depending upon the context. For many types of research, clinical classification criteria are necessary. The increasing prevalence of gout, advances in therapeutics, and the development of international research collaborations to understand the impact, mechanisms and optimal treatment of this condition emphasize the need for accurate and uniform classification criteria for gout. Five clinical classification criteria for gout currently exist. However, none of the currently available criteria has been adequately validated. An international mixed-methods project is currently underway to develop new validated gout classification criteria. These criteria will be an essential step forward to advance the research agenda in the modern era of gout management. Keywords: gout, classification, urate, research
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4 Classification criteria are designed to mimic a gold-standard in order to distinguish between disease and no disease or between different diseases. Their purpose is to ensure relative homogeneity of participants of clinical research, including clinical trials and epidemiological studies. Unbiased and reliable classification criteria are essential for research in rheumatic disease. Specific recommendations exist regarding development and validation of classification criteria for rheumatic disease [1]. Development requires identification of possible inclusion and exclusion criteria. A large sample of patients with and without disease should be studied to determine which criteria (or combination of criteria) best differentiate those with and without disease. The final classification criteria should then be validated in a large sample of cases and controls distinct from patients used to develop the criteria. Why do we need gout classification criteria? The classification of a patient as having of gout normally relies upon the identification of monosodium urate (MSU) crystals in synovial fluid or tissue [2]. Where examination of synovial fluid is impractical, the best approach differs depending upon the context: in clinical management of individual patients, all available information should be carefully weighed and considered by the physician, whereas in clinical research, classification criteria are necessary. Important advances have been made that emphasize the need for robust gout classification criteria. These advances include new (and expensive) pharmaceuticals and the need for accurate case-definition for recruitment into clinical trials; the advent of new imaging modalities that have the potential to change the way gout is classified; and the need for accurate phenotyping for large genetic studies, such as genome-wide association studies. Because of potential anticipated as well as unknown adverse effects of new agents for gout (including biologics), classification criteria need to have acceptable high specificity to ensure
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5 trial enrolment is targeting those with definite gout. At the same time, with the rise in incidence/prevalence of gout worldwide, uniform criteria with appropriate sensitivity and specificity are needed for epidemiologic studies as well as the phenotyping for genetic studies. New imaging modalities that were not available when prior criteria were developed need to be evaluated for their utility in aiding accurate classification of persons with gout. Limitations of current gout classification criteria There have been five published classification criteria for gout [3-7] (Table 1). None of the published gout criteria meet the requirements for valid classification criteria (Table 2). The Rome and New York criteria [3, 4] identify key features of gout but were not developed through observed prospective data and have been tested only to a limited extent. A study of 22 patients with clinically diagnosed gout in Sudbury, Massachusetts found that eight patients satisfied the Rome criteria only, four the New York criteria only and ten satisfied both sets (sensitivity of 0.82 and 0.64 for the Rome and New York criteria respectively) [8]. A much larger study of consecutive rheumatology clinic attendees from six European centres (59 patients with gout and 761 patients with other rheumatic diseases) reported that the specificity of both sets were very high (0.99 for both Rome and New York) but the sensitivity was not (0.64 and 0.80 for the Rome and New York criteria, respectively) [9]. The inclusion of tophi as key features may limit the sensitivity of these criteria in patients in early disease, since only 31% of patients with gout had a definite tophus in the larger study. The 1977 American Rheumatism Association (ARA) criteria, now over 30 years old, were informed by data to identify the acute arthritis of primary gout [5] (Table 1). Survey criteria that do not require joint aspiration were also described for use in epidemiological studies (11 items). The cases and controls were drawn from 706 patients submitted by 38
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6 rheumatologists across the US. Only patients with rheumatoid arthritis (RA), acute calcium pyrophosphate crystal arthritis and acute septic arthritis were accepted as controls. Important disease mimics including osteoarthritis and psoriatic arthritis were not included. The gold-standard chosen for the classification criteria was physician diagnosis. Many patients had incomplete data (for example, approximately half of the cases and the controls did not have synovial fluid analysis). The observed performance of the proposed clinical criteria that do not require joint or tophus aspiration was sensitivity 85% and specificity 97%. External validation of the clinical components of ARA criteria against a gold standard of synovial fluid analysis has been reported in two studies [10, 11]. In these studies the sensitivity was 70% and 80%, specificity was 79% and 64%. In contrast, in patients with crystal proof, sensitivity of 2 of 3 clinical components of the Rome criteria was 67% and specificity was 89% [10]. These results underscore the need for better criteria and that the gold-standard for diagnosis remains identification of MSU crystals in synovial fluid, preferably in the acute phase. Notwithstanding the problems of classification for acute gouty arthritis, there is also a need for classification criteria for intercritical or chronic gout. In most clinical research settings, participants will not have acute gout at the time of evaluation so that it is clearly necessary to develop classification criteria that do not require current evidence of active joint inflammation. There have been two further criteria recently proposed for diagnosis, not classification, developed in Mexico and the Netherlands [6, 7] (Table 1). The study from Mexico considered only patients with physician-diagnosed gout from rheumatology clinics. It proposed a simplified version of the 1977 ARA criteria based on the frequency of the items
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7 present in this population of patients. Because there were no control patients, the specificity of the suggested criteria could not be determined. A second study from this group showed a very high sensitivity (97%) and specificity (96%) in rheumatology clinic patients with crystal proven gout and other rheumatic diseases (osteoarthritis, spondyloarthritis, rheumatoid arthritis) [12]. However, the non-gout control patients in this study did not undergo synovial fluid analysis and the high rate of tophi (81%) in the gout cases limit general applicability. The Dutch study aimed to develop a diagnostic decision aid for general practitioners, rather than classification criteria. The patients for this study were required to have monoarthritis, so that the decision rule is not applicable to patients who present with more than one affected joint. Discriminating features included risk factors for gout (such as serum urate levels, male gender and cardiovascular disease) rather than actual manifestations of gout. MSU crystal identification: the 'gold standard' For most rheumatic diseases, a pathological diagnosis is not available and the gold-standard is often expert physician judgement (ideally made over a reasonable follow-up duration). This is not the case in gout, where the identification of tissue or synovial fluid MSU crystals is considered pathognomonic and the gold standard for diagnosis. Although the pathological diagnosis of gout through identification of MSU crystals is a major advantage when developing gout classification criteria, this 'gold standard' does have its limitations. Most importantly, MSU crystal identification is dependent on an operator who requires adequate training in synovial fluid crystal analysis [13, 14]. Other joint crystals and artefacts may mimic MSU crystals, and both false positive and false negative results may occur [15-17]. Another important consideration is that synovial fluid MSU crystals are present in a proportion of patients with asymptomatic hyperuricaemia; that is, elevated serum urate concentrations without overt clinical manifestations of gout [18, 19]. Whether these people
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8 should be considered as having gout can be debated. MSU crystals may also be present in patients presenting with joint inflammation due to concomitant rheumatic conditions including septic arthritis, acute calcium pyrophosphate crystal arthritis, psoriatic arthritis, and rarely rheumatoid arthritis, but these patients should still be classified as having gout but with confounding features. Following long-term intensive urate-lowering therapy, a negative urate balance is reached and MSU crystals will become undetectable [20]. A further barrier to crystal identification may be expertise in joint aspiration; while joint aspiration is standard in secondary rheumatology care, these skills may not be universally present in primary care where most gout is diagnosed and managed. Furthermore, gout frequently presents in small joints that may be poorly accessible to joint aspiration. Therefore, inclusion of MSU crystal identification as the gold standard for classification development risks oversampling patients with large joint arthropathy or tophaceous gout (if tophi are easily accessible for aspiration), which may be a source of bias when developing classification criteria using MSU crystals as the gold standard. Imaging considerations The 1977 ARA classification criteria for the acute arthritis of primary gout include plain radiographic changes of asymmetric swelling within a joint, and subcortical cysts without erosions [5]. These changes may be observed in conditions other than gout and are a late feature of disease [21]. Other plain radiographic features of gout such as soft-tissue opacifications with densities between soft tissue and bone, articular and periarticular bone erosions, and osteophytes at margins of opacifications or erosions have low sensitivity (31%) but high specificity (93%) for a clinical diagnosis of gout [22].
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9 No published classification criteria include advanced imaging techniques for detection of gout. Recent reports suggest that ultrasonography (US) and dual energy computed tomography (DECT) may allow accurate identification of some patients with gout. The double contour sign on US is defined as "a hyperechoic band over anechoic cartilage" [23] and is thought to represent MSU crystals coating articular cartilage [24]. A number of different groups have reported that the presence of the double contour sign on US has high specificity for gout (95-100%), with variable sensitivity (21-92%) [22, 23, 25-28]. Only a few imaging studies have used microscopic proven disease as a gold standard [23, 26]. A complicating issue is that these US features can also be present in people with asymptomatic hyperuricaemia [18, 28, 29]. DECT is a recently developed imaging method that allows visualisation of urate deposits through detection of the chemical composition of urate. High sensitivity and specificity has been reported for crystal proven gout by several groups [30-33]. It should be noted that most advanced imaging studies have examined the classification accuracy in patients with established disease, where joint aspirate could be achieved, or other clinical criteria would be satisfied. False negative cases have been reported [34]. The role of these techniques for gout classification in patients with early disease and any additional benefit over microscopic or clinical criteria requires careful consideration. Scope of gout classification criteria The purpose of classification criteria is to robustly define cases of gout for the purposes of research. It is not intended that these criteria are used for gout diagnosis in clinical practice. In clinical practice, the diagnosis of gout should be made by microscopy, and if this is not possible, a tentative clinical diagnosis is made taking into account history, examination, imaging and laboratory findings in an individualised manner. Gout may present in a number of different ways: recurrent flares, chronic gouty arthropathy, and tophaceous disease. Gout
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10 classification criteria should accurately capture patients with these various disease states. However, the scope of classification criteria does not include definition of these disease states in patients with gout. Furthermore, the classification of gout applies to patients with clinical features of gout, and does not aim to define a 'pre-gout' state that may potentially be characterised by deposition of urate crystals in the absence of clinical manifestations. A strategy to develop new gout classification criteria The American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) have recently funded an international project to develop new gout classification criteria. The intent of criteria derived from this work is to improve the case-definition for gout amongst both primary and secondary care populations. The intended use of classification criteria in this setting includes case ascertainment for recruitment into clinical studies, including observational studies and randomised controlled trials. Following item generation processes involving both physicians and patients [35], two parallel approaches will be used to determine the key combination of elements that best define gout. The first approach will involve prospectively recruiting 860 patients with suspected gout into a multicentre international study. All participants will have synovial or tissue analysis (by an observer certified in crystal identification) to determine true-status classification. The second approach will be a paper patient exercise where thirty patient profiles that represent a spectrum of gout probability will be ranked by an expert panel. Additional data will be a systematic review of the diagnostic utility of advanced imaging for gout and analysis of trade-offs of sensitivity and specificity for different contexts of classification. A structured consensus process will then integrate these sources of data into agreed classification criteria. The overall project strategy is shown schematically in Figure 1. The final criteria will be in a format similar to the 2010 ACR/EULAR RA criteria [37]. It is possible that different but
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11 equivalent versions of criteria will be recommended (with or without advanced imaging). The final criteria will be externally validated using a test sample from the multicentre international study and an existing primary care dataset. Summary Gout is now the most common inflammatory arthritis [43]. The increasing prevalence of gout, advances in therapeutics, and the development of large international research collaborations to understand the impact, mechanisms and optimal treatment of this condition emphasize the need for accurate and robust classification criteria for this disease. These criteria will be an essential step forward to progress the research agenda in the modern era of gout management.
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12 Key messages 1. Unbiased and reliable classification criteria are essential for research in rheumatic disease. 2. Current classification criteria for gout are limited by low sensitivity and incomplete validation. 3. An international project is underway to develop classification criteria that closely mimic crystal-proven gout.
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13 References 1 criteria for rheumatic diseases. Arthritis Rheum 2006;55(3):348-52. 2 Zhang W, Doherty M, Pascual E, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65(10):1301-11. 3 Kellgren JH, Jeffery MR, Ball JF. The Epidemiology of Chronic Rheumatism. In. Oxford: Blackwell Scientific; 1963. 4 Decker JL. Report from the subcommittee on diagnostic criteria for gout. In: Bennett PH, Wood PHN, eds. Population studies of the rheumatic diseases - Proceedings of the third International Symposium New York, June 5-10, 1966. Amsterdam: Excerpta Medica Foundation; 1968:385-7. 5 Wallace SL, Robinson H, Masi AT, Decker JL, McCarty DJ, Yu TF. Preliminary criteria for the classification of the acute arthritis of primary gout. Arthritis Rheum. 1977;20(3):895-900. 6 Pelaez-Ballestas I, Hernandez Cuevas C, Burgos-Vargas R, et al. Diagnosis of chronic gout: evaluating the american college of rheumatology proposal, European league against rheumatism recommendations, and clinical judgment. J. Rheumatol. 2010;37(8):1743-8. 7 Janssens HJ, Fransen J, van de Lisdonk EH, van Riel PL, van Weel C, Janssen M. A diagnostic rule for acute gouty arthritis in primary care without joint fluid analysis. Arch. Intern. Med. 2010;170(13):1120-6. 8 O'Sullivan JB. Gout in a New England town. A prevalence study in Sudbury, Massachusetts. Ann. Rheum. Dis. 1972;31(3):166-9. 9 Rigby AS, Wood PHN. Serum uric acid levels and gout: what does this herald for the population? Clin. Exp. Rheumatol. 1994;12:395-400. 10 Malik A, Schumacher HR, Dinnella JE, Clayburne GM. Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis. JCR: Journal of Clinical Rheumatology 2009;15(1):22-4. 11 Janssens HJEM, Janssen M, van de Lisdonk EH, Fransen J, van Riel PLCM, van Weel C. Limited validity of the American College of Rheumatology criteria for classifying patients with gout in primary care. Ann. Rheum. Dis. 2009:-. 12 Vazquez-Mellado J, Hernandez-Cuevas CB, Alvarez-Hernandez E, et al. The diagnostic value of the proposal for clinical gout diagnosis (CGD). Clin Rheumatol 2012;31(3):429-34. 13 Schumacher HR, Chen LX, Mandell BF. The time has come to incorporate more teaching and formalized assessment of skills in synovial fluid analysis into rheumatology training programs. Arthritis Care Res (Hoboken) 2012;64(9):1271-3. 14 Schumacher HR, Chen LX, Zhang LY. Diagnosis of crystal-associated disease: where do we stand? Bioanalysis 2011;3(10):1081-3. 15 Gordon C, Swan A, Dieppe P. Detection of crystals in synovial fluids by light microscopy: sensitivity and reliability. Ann Rheum Dis 1989;48(9):737-42. 16 Schumacher HR, Reginato AJ. Atlas of synovial fluid analysis and crystal identification. Philadelphia: Lea & Febiger; 1991. 17 Jansen TL, Rasker JJ. Therapeutic consequences of crystals in the synovial fluid: a review for clinicians. Clinical and experimental rheumatology 2011;29(6):1032-9. 18 De Miguel E, Puig JG, Castillo C, Peiteado D, Torres RJ, Martin-Mola E. Diagnosis of gout in patients with asymptomatic hyperuricaemia: a pilot ultrasound study. Ann Rheum Dis 2012;71(1):157-8. 19 Rouault T, Caldwell DS, Holmes EW. Aspiration of the asymptomatic metatarsophalangeal joint in gout patients and hyperuricemic controls. Arthritis Rheum 1982;25(2):209-12. 20 Li-Yu J, Clayburne G, Sieck M, et al. Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? J Rheumatol 2001;28(3):577-80. Singh JA, Solomon DH, Dougados M, et al. Development of classification and response
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14 21 clinical and radiographic assessment. Arthritis Rheum 1984;27(4):468-71. 22 Rettenbacher T, Ennemoser S, Weirich H, et al. Diagnostic imaging of gout: comparison of high-resolution US versus conventional X-ray. European radiology 2008;18(3):621-30. 23 Thiele RG, Schlesinger N. Diagnosis of gout by ultrasound. Rheumatology (Oxford) 2007;46(7):1116-21. 24 Grassi W, Meenagh G, Pascual E, Filippucci E. "Crystal clear"-sonographic assessment of gout and calcium pyrophosphate deposition disease. Seminars in arthritis and rheumatism 2006;36(3):197-202. 25 Wright SA, Filippucci E, McVeigh C, et al. High-resolution ultrasonography of the first metatarsal phalangeal joint in gout: a controlled study. Annals of the rheumatic diseases 2007;66(7):859-64. 26 Ottaviani S, Richette P, Allard A, Ora J, Bardin T. Ultrasonography in gout: a case-control study. Clinical and experimental rheumatology 2012. 27 Filippucci E, Riveros MG, Georgescu D, Salaffi F, Grassi W. Hyaline cartilage involvement in patients with gout and calcium pyrophosphate deposition disease. An ultrasound study. Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society 2009;17(2):178-81. 28 Howard RG, Pillinger MH, Gyftopoulos S, Thiele RG, Swearingen CJ, Samuels J. Reproducibility of musculoskeletal ultrasound for determining monosodium urate deposition: concordance between readers. Arthritis care & research 2011;63(10):1456-62. 29 Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis research & therapy 2011;13(1):R4. 30 Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Annals of the rheumatic diseases 2009;68(10):1609-12. 31 Choi HK, Burns LC, Shojania K, et al. Dual energy CT in gout: a prospective validation study. Annals of the rheumatic diseases 2012. 32 Glazebrook KN, Guimaraes LS, Murthy NS, et al. Identification of intraarticular and periarticular uric acid crystals with dual-energy CT: initial evaluation. Radiology 2011;261(2):516-24. 33 Bongartz T, Glazebrook KN, Kavros SJ, et al. Diagnosis of gout using dual-energy computed tomography: an accuracy and diagnostic yield study In: American College of Rheumatology Annual Scientific Meeting. Chicago, IL. 34 Glazebrook KN, Kakar S, Ida CM, Laurini JA, Moder KG, Leng S. False-negative dual-energy computed tomography in a patient with acute gout. J Clin Rheumatol 2012;18(3):138-41. 35 Prowse RL, Dalbeth N, Kavanaugh A, et al. A Delphi exercise to identify characteristic features of gout – a study of opinions from patients and physicians, as the first stage in developing new classification criteria for gout. J Rheumatol 2012:in press. 36 Prowse R, Dalbeth N, Schumacher HR, et al. A Delphi Exercise to Identify Characteristic Features of Gout - a Study of Opinions from Patients and Physicians to Inform New Classification Criteria. In: American College of Rheumatology Annual Scientific Meeting. Washington DC. 37 Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69(9):1580-8. 38 Symmons D, Lunt M, Watkins G, et al. Developing classification criteria for peripheral joint psoriatic arthritis. Step I. Establishing whether the rheumatologist's opinion on the diagnosis can be used as the "gold standard". J. Rheumatol. 2006;33(3):552-7. 39 Neogi T, Aletaha D, Silman AJ, et al. The 2010 American College of Rheumatology/European League Against Rheumatism classification criteria for rheumatoid arthritis: Phase 2 methodological report. Arthritis Rheum 2010;62(9):2582-91. 40 Jones CM, Athanasiou T. Diagnostic accuracy meta-analysis: review of an important tool in radiological research and decision making. Br. J. Radiol. 2009;82(978):441-6. Nakayama DA, Barthelemy C, Carrera G, Lightfoot RW, Jr., Wortmann RL. Tophaceous gout: a
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15 41 preferences for carotid artery testing. J Health Serv Res Policy 2008;13(2):61-6. 42 Hansen P, Ombler F. A new method for scoring additive multi-attribute value models using pairwise rankings of alternatives. J Multi-Crit Decis Anal 2009;15:87–107. 43 Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008. Arthritis Rheum 2011;63(10):3136-41. Sassi F, McKee M. Do clinicians always maximize patient outcomes? A conjoint analysis of
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|Reviews for Somewhere in between
| girrly chapter 28 . 1/5/2012
Ohh yeah, and, :PLEASE UPDATE!
| girrly chapter 28 . 1/5/2012
wow this is good! i just wish sam could be in it more...
| Viator-Porta chapter 28 . 8/27/2007
hey nice job can wait for the next chapie, if your wondering when i finish all chps that are up for a story thats when i review, i don't review every chap, i know i shold but i'm really lazy LOL.
| Hope and love chapter 28 . 6/24/2007
i love it!
| smrvn chapter 28 . 8/15/2006
This is a really cool story I hope you'll be updating soon.
| Irresistibly desired chapter 28 . 5/29/2006
| Caroline ONeill chapter 28 . 1/10/2006
You can not leave it there. Please get next chapters soon
| EllipsisObsessed chapter 28 . 9/3/2005
awsome story please update soon D
| kasluvs chapter 28 . 7/31/2005
I really like your story so far! And I love the Jack/Katie dynamic! : ) Update Soon!
| whatever90 chapter 28 . 7/31/2005
great story when u gonna finish it?
| Jistone chapter 23 . 6/23/2005
where in the world did you come up with a name like Talq'ansowped? never mind i don't think i want to know, well i am going to go read the next chapter. great story by the way.
| CMDR.Roberts chapter 28 . 6/14/2005
I love the story but come on its been over a year and no post you can't leave us hanging like that.
| starfish chapter 28 . 2/15/2005
hey does anyone know if this story is gonna be updated?
| albeno chapter 1 . 1/28/2005
hey loving the story, plz tell me ur gonna update it son. im a stargate-holic and this story has me hooked.
| anon reader chapter 28 . 1/17/2005
the constant reminders to give you feedback seem to have worked. i rarely give any. this is because i have a bad habit of criticising too much no matter how much i love the story. bear in mind, i really enjoyed reading your fic and would not have written this otherwise. so here goes: i love the charater Katie, you wrote her exceedingly well, very much like Jack, my only complaint is that she seems to be almost a female copy of Jack, she could be better with a bit more of Sam or individuality mixed in, but well done despite (the femminism was good). Your writting in general is great reading, as in all good books it seems shorter than it is, as time flies. one thing i've noticed is tfic since march last year, so i dont think i have much chance of finding out what happens to Katie. oh well, i shall read some of your other fics. (btw this is the first one of yours i've read) thanx for a good read. :) -anon


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Unemployed graduates gathered in Colombo today for a demonstration, demanding jobs in the public sector, and the formulation of a national job policy for graduates. Captured here are scenes from the demonstr
Unemployed graduates gathered in Colombo today for a demonstration, demanding jobs in the public sector, and the formulation of a national job policy for graduates. Captured here are scenes from the demonstr
Former minister Janaka Bandara Tennakoon who was arrested by Criminal Investigations Department (CID) over a murder incident in 1999, remanded till October 20 by Colombo magistrate today.
The Jaffna High Court today sentenced four soldiers into 25 Rigorous Imprisonment (RI) each over a gang rape and sexual abuse incidents in Viswamadhu, Kilinochchi. The incident took place in 2010, shortly after the en
Sri Lanka Prime Minister Ranil wickremasinghe and his wife Maithre Wickremasinghe met Japanese Emperor Akihito and Empress Michiko at the Imperial palace in Tokyo on October 07,2015. Mr Wickremasinghe arrived on O
The second annual real estate conference will take place on October 21, 2015, from 3pm - 8pm, at the Bandaranaike Memorial International Conference Hall, according to a statement released by Lamudi.lk In addition to
The maximum limit of the facility for Sri Lankan vehicle leasing will be increased to 90 per cent from 70 per cent with effect from Monday October 5, Finance Minister Ravi Karunanayake announced at a media conferen
The Sri Lankan Government on Friday offered an amnesty to Sri Lankans holding 'secret numbered' accounts totaling $10-15 billion in Swiss banks saying they could bring their money back with no questions asked and no
Falck, the world's largest ambulance service, said this week it was pulling out of Sri Lanka this month – just two years after its entry – stymied by the new Indian Government-backed free ambulance servic
The radiant, young Thilini Amarasooriya was crowned the Siyatha-Facia Miss World Sri Lanka 2015 at a glittering final pageant held at Grand Ballroom Colombo Hilton recently . Jayathi De Silva was adjudged the First R
Colombo Fashion Week (CFW) recently presented the fourth edition of the HSBC CFW Resort hosted by Jetwing Hotels; as leading Sri Lankan and international designers showcase their latest resortwear collections on the runw
Colombo Fashion Week (CFW) recently presented the fourth edition of the HSBC CFW Resort hosted by Jetwing Hotels; as leading Sri Lankan and international designers showcase their latest resortwear collections on the runw
Ladies College defeated Bishops College 1-0 and also won the under 17 game by the same margin to clinch the Overall Championship at the 11th Ladies-Bishops hockey encounter for the LC/BC trophy played at the Astro Turf o
The Royal College won the Western Province Under-18 Hockey championship for the third year running after beating Nalanda College in the final at Royal College grounds. Royal edged out Nalanda by 4-3 in penal
The three-day warm up game between the touring West Indies and the Sri Lanka Cricket Board President's XI has been rescheduled by a day. The match was to be played on October 8, 9 and 10 at the SSC and now
JAKARTA, Oct 7, 2015 (AFP) - New aerial footage released Wednesday showed smoke billowing from Indonesian forest fires as smog-choked Singapore's biggest supermarket chain announced a ban on products from a paper compan
ISLAMABAD, Oct 7 (Reuters) - Pakistan's highest court on Wednesday upheld the death sentence for the killer of the governor of the country's wealthiest and most populous province after he had called for reform of the bl
GENEVA, Oct 7 (Reuters) - Medecins Sans Frontieres (MSF) called on Wednesday for an independent international fact-finding commission to be established to investigate the U.S. bombing of its hospital in Kunduz, Afghanis
LONDON, Oct 7, 2015 (AFP) - Pakistani activist Liaquat Ali Hazara had his application for asylum in Britain turned down 2 years ago. He has been stuck in limbo since, afraid of being killed by the Taliban if he is sent
SEOUL, Oct 7, 2015 (AFP) - When it comes to grandiose, mass displays of State muscle and military grandstanding, North Korea has few equals. This Saturday, the reclusive, and diplomatically elusive North is set to put
MUZAFFARABAD, Pakistan, Oct 7, 2015 (AFP) - The morning the Pakistan earthquake struck 10 years ago, Nazish Naz had been reluctant to go to school, telling her elder sister the day felt cursed. Less than an hour after


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Milk kefir grains are live active cultures consisting of yeast and bacteria existing in a symbiotic relationship. Adding the kefir grains to fresh milk yields a delicious probiotic drink in about 24 hours. Milk kefir can be enjoyed plain, flavored, or used in many recipes, like salad dressing, bread, and ice cream.
- Contains 1 packet of traditional heirloom-style milk kefir grains.
- Rehydration period of 3-7 days required before regular use.
- Reusable culture; makes up to 1 quart of kefir with every batch
- Cultures on the counter at 68°-85°F
- Suitable for use with cow or goat milk.
- Grains require rehydration in pasteurized dairy milk. Once rehydrated, grains may be transitioned to raw milk.
- May be used to culture coconut, soy, or rice milk once rehydrated in dairy milk; grains require regular refreshing in dairy milk.
- Nut and seed milks yield inconsistent results.
Milk Kefir Grains Instructions and Troubleshooting:
- Instructions for using this culture are included and may be found here.
- Having trouble making milk kefir? Browse our Milk Kefir Troubleshooting Articles or contact us for assistance.
Ingredients: Organic powdered milk, organic milk, live active cultures. Packaged in a small amount of organic powdered milk to extend shelf life.
This product contains no GMO ingredients.
Shipping Information: Our milk kefir grains are shipped in a dehydrated state in a barrier-sealed packet. The product keeps
- At room temperature (68° to 78°F): 12 to 18 months
- In the refrigerator (40° to 45°F): 18+ months
- In the freezer (0° to 25°F): not recommended
Milk Kefir Grains Allergen Information:
Our Milk Kefir Grains are a gluten-free product. Manufactured in a facility that produces products made with soy and dairy.
You may also be interested in the following product(s)
Milk Kefir Starter Kit$23.99
Questions on Milk Kefir Grains
- From Jackie at 3/19/2013 3:28 PM
- How many different strands of bacteria is in your kefir grain?
- This is a list of the specific set of active bacteria and yeast generally known to comprise Milk Kefir Grains:
- Do you find this question helpful? Yes No
- From patricia at 3/22/2013 7:30 PM
- If I want to take a break from making kefir how do I go about doing that? Will I lose my kefir grains and have to order more? I work and it is not easy for me to keep making it just for myself. I don't see an answer to that on the instructions for milk kefir grains.
- For an occasional break, you can try the following: http://www.culturesforhealth.com/how-to-take-a-break-from-making-kefir
However, we recommend that you keep your kefir culturing at room temperature, as much as possible, to avoid stressing the grains. Too many breaks and the grains may eventually cease working.
- Do you find this question helpful? Yes No
- From Logan at 3/25/2013 10:00 PM
- I rehydrated my water kefir. It was doing great for a few weeks. I put the grains in a plastic mesh satchel cause I didn't have muslin. I premade the sugar water and put them in jars because someone was watching my house. They changed the water every 3 days. When I came back though my grains were kinda mushy and small. Can they be revived?
- You may be able to revive them with the following procedure: http://www.culturesforhealth.com/rehabilitating-fixing-repairing-damaged-water-kefir-grains It may take several rounds of rehab for this to help.
Also, the next time you go away, you might try the information here:
- Do you find this question helpful? Yes No
- From Nancy Shaeffer at 4/24/2013 4:49 PM
- We would like to flavor the kefir with vanilla or chocolate or fruit. How do you do that without ruining the kefir?
- Here is a great article on how to flavor your milk kefir: http://www.culturesforhealth.com/second-fermentation-milk-kefir
- Do you find this question helpful? Yes No
- From Jeanne at 4/28/2013 1:59 PM
- I have been making my kefir with raw goat milk and kefir starter that someone gave me. I have been using my yogurt maker because the temperature in the house is quite often below 70 degrees. It has almost always have the same wonderful thick consistency and very good. Now I just read I should not be using my yogurt maker. What was made was too thick and good to be soured milk.
Your thoughts.
- If you were getting good results with your yogurt maker, it may be fine. Normally, yogurt makers maintain 110ºF, which would be too hot for milk kefir. Milk kefir prefers to stay between 68-85ºF. Higher temperatures may kill the kefir grains. As long as it was working for you and making good kefir, your method should be just fine.
- Do you find this question helpful? Yes No
- I have been making my kefir with raw goat milk and kefir starter that someone gave me. I have been using my yogurt maker because the temperature in the house is quite often below 70 degrees. It has almost always have the same wonderful thick consistency and very good. Now I just read I should not be using my yogurt maker. What was made was too thick and good to be soured milk.
- From Bethany at 5/4/2013 9:36 AM
- Can I add water to my coconut milk to "stretch" it out before I add my kefir grains? Also, can coconut milk turn to curds and whey...I guess I am wondering if I can over ferment coconut milk?
- Adding a small amount of water would likely be fine since coconut milk is a combination of coconut meat and water that has been blended. You can even make your own coconut milk! http://www.culturesforhealth.com/coconut-milk-kefir-recipe
Coconut milk kefir can separate, so it is important to stay within the recommended culture time as well as keeping an eye on the process.
- Do you find this question helpful? Yes No
- From non dairy girl at 5/10/2013 7:16 AM
- I am lactose intolerant and use lactaid milk on my cereal. It is skim fat free milk with lactose added. Will this still work?
- Maybe. Lactose-free milk isn't actually lactose-free, but has lactase added, which makes the lactose easier to digest. Check the label and if you see lactase, the milk does contain lactose and may be used with milk kefir grains. Avoid ultra-pasteurized milk for making milk kefir.
- Do you find this question helpful? Yes No
- From SB325 at 5/17/2013 9:18 PM
- I believe I will consume about 1 cup of kefir per day. Can I culture this small amount daily, or should I plan to culture more milk less often?
- To make smaller batches, you'll need to reduce the number of grains you are using, or else the milk will kefir too quickly. For more information about timing milk kefir, see this article: http://www.culturesforhealth.com/timing-milk-kefir
While you can take an occasional break, such as for a vacation, the cultures are healthiest when they're active. It's best to make a smaller batch every day, than to rest the grains too often. Here are other suggestions for taking a break from making kefir: http://www.culturesforhealth.com/how-to-take-a-break-from-making-kefir
- Do you find this question helpful? Yes No
- From SB325 at 5/21/2013 5:04 PM
- Thank you for promptly answering my last question. I have another.
I received my grains and began revitalizing them. I began changing the milk every 12 hours, for 3 days. Then let it ferment for 24 hours. Now, about 5 days later, my grains are growing/plumping up and make about 1.5 cups of milk nice and thick in 24 hours. Quite unexpectedly, I must leave town and will be unable to tend to my kefir for about 10 days. I read the link provided regarding taking a break from making kefir. My question, should I use the same amount of milk I have been fermenting (about 1.5C), or should I use more? Will the fact they are just getting restarted effect how well they survive storage? When I bring them back out of storage, will I need to revitalize them like I did the dried grains?
Thank you!
- You can use the same amount of milk you have been using. Sometimes if they are brand new they do not do as well in storage. Since they are new, revitalizing them would be recommended. Use new milk and do two or more batches until they are making good kefir again.
- Do you find this question helpful? Yes No
- Thank you for promptly answering my last question. I have another.
- From Luke at 5/22/2013 8:39 AM
- My kefir went a little long and seperated into curds and whey. Now I can't tell what is curds and what is the kefir grains. Any suggestions?
- If you have the nylon/plastic mesh strainer, gently stir the curd in the strainer with a rubber spatula or wooden spoon. This should remove some of the curd, then use the spatula/spoon to very gently press down on the curd. The soft curd will go through the strainer and the grains will remain. It might be helpful to rinse with new milk if it's hard to get the curds off. Be sure to make kefir cheese out of the curd! You'll find the recipe here: http://www.culturesforhealth.com/herbed-soft-kefir-cheese-recipe/
- Do you find this question helpful? Yes No
Ask Your Own QuestionBack to the product page
Customer Reviews
- Thumbs up Review by Jenifer
Price Value Quality
The grains started production very nice kefir just a few days after I rehydrated them. The amount of grains was smaller than I had anticipated, but they produce the perfect amount of kefir every 24 hours, so I am very happy with the end result. I highly recommend anyone purchasing the grains to have a plastic strainer like the ones sold on this website to strain the grains with.
(Posted on 9/20/2015)
- Love my daily kefir Review by KB
Price Value Quality
I have a tsp of grains and can get 2.5 c every 24hrs. I let it sit on counter 8 hrs ....until morning.
In the morning I add some lemon juice and put it in fridge until next morning! Yummy. ***I usually put in freezer for 30 min before drinking half. I drink the rest before dinner. I don't see an increase in grains yet so will try different milk.
It did take about 7-8 days to activate. Worth the wait!
(Posted on 9/20/2015)
- Great product Review by Joflo
Price Value Quality
I'm glad I was able to find this company to order my grains.a good safe way to get the cultures I needed. My grains were in the mailbox in the heat all day So they little slow to produce but once they got going I started getting nice tasty kefir.
(Posted on 9/17/2015)
- super potent Review by Raquel
Price Value Quality
This is actually the second batch I purchase because my kitchen helper threw out my beautiful grains by accident :( This time I activated about a third of the grains since it's only for two people and they end up making way more kefir than I need. Now if there is another accident I have some sleeping in the fridge!
(Posted on 9/15/2015)
- love it Review by nicetracyj
Price Value Quality
i bought it for my dad... it taste great.. it is of great quality.. and i feel different drinking it..
(Posted on 9/5/2015)
- Worked Good for me Review by DTS
Quality Price Value
The first batch had an off flavor, but by the second batch it was drinkable. I've been using them for a couple of months now, and they are finally starting to grow. All in all I am very satisfied.
(Posted on 9/4/2015)
- no success at all Review by Barb
Price Value Quality
I've wasted a whole bunch of milk trying to get this to work. I go from nothing but milk to clots of disgusting stuff over the course of a couple of hours. I'm an experienced cook and make my own yogurt and beer, I am capable of following instructions, I haven't yet gotten this to work and I'm thinking of dumping my grains down the sink before I waste any more milk and time on this. Maybe I'm not recognizing when it's time to call it done, but clearly the instructions are inadequate. Oh, I supposed I should mention that I have a Ph.D.
Response from CFH: Clumpy kefir is a sign of overcultured, hungry grains. Please contact customer support as soon as possible, as most cultures can be saved with a little troubleshooting.
(Posted on 8/26/2015)
- Milk Kefir Grains are Super Quality Review by Penny
Value Quality Price
I am so happy with how well the milk kefir grains I purchased from Cultures for Health are producing kefir. This is my first attempt at making kefir, and I'm thrilled with the success. I've had the grains less than a month, and after just two "conditioning" ferments my new grains have been making delicious and healthy kefir every single day. And the grains are increasing in size very nicely! So glad I made the leap into making kefir, and so very pleased with the quality of Cultures for Health grains.
(Posted on 8/23/2015)
- very good quality Review by eman1958
Quality Price Value
i was so happy with the quality, i did an amazing kefir with it. it is very easy to follow the instructions too.
(Posted on 8/12/2015)
- Good Review by Sarah
Value Quality Price
I try to be careful when I strain the grains but it seems my grains become fewer and fewer so that after a few weeks I have just 2 or 3 left. And I feel the price is a little expensive.
Note from CFH: Decreasing grains is usually a sign the grains are starving. Please contact customer support for troubleshooting.
(Posted on 8/3/2015)
- So Glad I FINALLY started Kefir Culturing Review by llw
Value Quality Price
Love your produce. Excellent videos on your site to get started. Thanks!
(Posted on 8/2/2015)
- No Problems Review by Jack
Price Value Quality
Started the grains per instructions with Raw Milk. They were active right after the start period and have worked well for the last month. They are growing slowly and the kefir tastes great--I do a primary for 24 hours and a secondary for an additional 24 hours. I make just under 1 quart a day. Fortunately have 2 raw milk sources within a few miles.
(Posted on 7/13/2015)
- Success! Review by zelda
Price Value Quality
I am a happy customer! The Milk Kefir Grains worked perfectly. The instructions included were so helpful. I had no problems starting my kefir, and it has been going strong for several weeks now. All of my questions were answered well by the online resources here on the Cultures For Health site. This was my first home fermentation project, and I would definitely order another starter from Cultures For Health if I decide to take on another. Thanks for making an awesome product, and maintaining a super helpful website.
(Posted on 7/6/2015)
- Didn't Work for Me Review by SweetBee
Price Value Quality
Ended up wasting at least a gallon or more of expensive organic milk refreshing the grains every day for almost two weeks before I just gave up and dumped them in the trash.
Such a small amount of grains and they never did smell right, smelled more like bread yeast than kefir.
I had good luck with the dehydrated powder and with the water kefir, don't think I'll waste more money trying these again.
CFH Note: Most kefir issues can be easily resolved with minor modifications to the kefir making process. It is very important that you contact Customer Support for help if you are experiencing problems.
(Posted on 6/23/2015)
- Love it! Review by Emm Vee
Price Value Quality
I bought my grains from a local health food store. It took a while and a few trials and errors to get consistent results, but the customer service reps were very helpful. I have been getting consistent results now for several months, and am very pleased with the end product. It's thick (even with skim milk) and pleasantly sour and yogurty. It takes five minutes each morning to give the little kefir-dudes some fresh milk, and they just do their thing. I'll be interested to see what happens in the hot and humid summer months.
(Posted on 6/17/2015)
- Challenging To Get Great Results Review by Suzanne
Quality Price Value
I was very challenged using these grains to make milk kefir. I followed the instructions to dehydrate the grains and make kefir. I used low pasteurized/non-homogenized milk. My process with the grains kept changing the milk into curds and whey. I was unable to recognize/see the grains in the finished product. I contacted Customer Support and the representative worked with me for almost a week to resolve these problems. No more curds and whey. Only great tasting milk kefir! Thank you CFH Customer Support.
(Posted on 6/15/2015)
- Fantastic quality! Review by Angel
Quality Price Value
Hint: don't even dare to rinse your grains in tap water. That's how I killed my first batch. I was dumb and thought I knew better. You don't need to rinse them at all unless you're taking some out to dry and save as a back up. Anyway, this is my second attempt to make kefir. These are fantastic quality grains and I definitely recommend them to anyone who wants to help themselves be healthier.
(Posted on 6/1/2015)
- Rehydrating Kefir grains Review by GardenGirl
Quality Price Value
It barely took a week until I had a quality home made kefir. I have divided my grains already!
(Posted on 5/16/2015)
- Love my home made kefir! Review by J
Quality Price Value
I love making kefir at home. It is much more economical then buying it and I get a lot of use out of the kefir in dressings, soups, smoothies and backed goods.
(Posted on 5/7/2015)
- great Review by Paula
Quality Price Value
I love these milk kefir grains, this is the second time I've ordered them. They make delicious milk kefir and I and my husband enjoy it every day. Thank you for a great product!
(Posted on 5/6/2015)
Starter cultures, rennet for cheese making and cultured vegetables, juices and condiments are sensitive to excessive heat. Once your order has shipped, an e-mail with tracking information will be sent to you. We encourage you to use the tracking information to anticipate the arrival of your items so they can be removed from the mail box and stored in the refrigerator promptly.
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SKE48 reveals short PV preview of "Okie Dokie"
As many of you already know, SKE48's 7th single "Okie Dokie" will be released on November 9th. Recently, the short PV preview of "Okie Dokie" was revealed through their official YouTube channel, along with two other tracks "Bazooka-hou Hassha!" (in Type-A), and "Hohoemi no Positive Thinking" (in Type-B). Check out the previews of some tracks from SKE48's upcoming single below! (Check our previous post for the track list here.) -- "O
Horikita Maki turns into a diligent woman for new 'Leopalace21' CM
Actress Horikita Maki has been appointed to be the image character for real estate company, 'Leoplace21', and will star in their new commercials. In the CM, Horikita plays a charming single woman, who lives alone in her nice little flat. She's about to go out, but first she has to diligently go through her imaginary checklist; "All doors and windows closed, done! - Lights out, done!" She does all that while pointing at the things with her
Crystal Kay to transfer labels + announces new single
Singer-songwriter Crystal Kay has announced that she will be transferring to Universal Music Japan's label, Delicious Deli Records! To coincide with this transfer, the singer has revealed that she will be releasing a new single on December 7th. Crystal expressed, "Finally, my first single release after the transfer has been decided! I'm nervous, but I'm filled with excitement! I want to create GOOD MUSIC utilizing my heart, body, and voice t
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the HIATUS announces 3rd album + nationwide tour
Alternative rock band the HIATUS has announced that they will be releasing their third album on November 23rd! The band has also revealed that they will be holding a nationwide tour, tentatively titled "the HIATUS TOUR 2011-2012", to coincide with the album release. The album, currently untitled, will be the band's first album since "ANOMALY", which was released back in June 2010. The title and track list will be revealed at a later date.
GLAY to release new mini-album in December
Rock group GLAY has revealed that they will be releasing a new mini-album, titled "Hope and The Silver Sunrise", on December 14th! This will be the third and final release of their three month consecutive release project, and it's said to be a Christmas mini-album containing five songs. It will come in both limited and regular editions, and the limited edition will come with a 2012 daily pad calendar. Regarding this new mini-album, member
Oricon reveals the monthly chart rankings for September
Check out the Oricon monthly chart rankings for September below. ----- <Single> 1. "Rising Sun/Itsuka Kitto..." - EXILE/EXILE ATSUSHI : 9/14 (234,846) 2. "Kazoku ni Naoru yo/fighting pose" - Fukuyama Masaharu : 8/31 (220,809) 3. "Magic Power" - Hey! Say! JUMP : 9/21 (217,661) 4. "Flying Get" - AKB48 : 8/24 (186,205) 5. "FIGHTERS" - 3daime J Soul Brothers : 9/7 (91,129) 6. "Niji no Uta" - Domoto Tsuyoshi : 9/7
Michibata Jessica becomes a model for TAG Heuer
On October 4th, model Michibata Jessica (26) attended an event for watch brand TAG Heuer in Tokyo. As the image character for this brand, this popular model showed up to the event in a long, black dress featuring a thigh-high slit and showed her muse-like figure to the audience. As the first Japanese to be chosen as the image character for this brand, she stated, "I really think of this as a great honor," and expressed her happiness with a
Dan Rei excited to meet Milla Jovovich at premiere for "The Three Musketeers 3D" in London
Actress Dan Rei attended the London premiere for the upcoming 3D movie "The Three Musketeers". She takes the role of the voice acting for the Japanese dubbed version. The voice over role she plays is for the mysterious beautiful woman Milady which is the role of Milla Jovovich. Dan got an invitation as a Japanese representative and walked on the red carpet wearing a white Kimono. Movie director Paul W. S. Anderson transformed the world ren
"Kaiji 2" press conference features 200 million Yen as the main star, and a peculiar Yoshitaka Yuriko
A press conference for the upcoming movie "Kaiji 2: Jinsei Dakkai Game" was held in Tokyo today. The conference was attended by actors Fujiwara Tatsuya, Iseya Yusuke, and Yoshitaka Yuriko, as well as director Sato Toya, and creator of the original manga, Fukumoto Nobuyuki. The movie is the sequel to the very successful "Kaiji: Jinsei Dakkai Game" that grossed 2.25 billion Yen (29.34 million USD) at the box office. Just like in the first mo


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@GeekyNicki's Latest Tweets
- Still very true: Kids can't use computers... and this is why it should worry you http://t.co/muxApz7xoZ by @coding2learn #compeduk about 1 week ago
- RT @bekblayton: My Latest Post: Just because our children can use an iPad…The Myth of Digital Natives http://t.co/LbgFi8LwqB #ukedchat #pr… about 1 week ago
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Each donor's circumstances are different and tax and other financial benefits may vary over time. There are a variety of planned giving options that may be used to help provide for personal needs and those of loved ones while also giving current, capital and/or endowment support for Truett-McConnell.
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Contact us today for more information on planned giving, please contact the Office of Institutional Advancement at 706.865.2134 Est. 132.
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Super 8 OKC Health Center
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Travel Blogs from Oklahoma City
Day 11, And Oklahoma city is mighty pretty!
... It's not a long run. First stop was Quapaw, On my list as an extra, it is nice to grabe the extra "Q". Onto my "M" Miami (called Miama by the locals) and Vinita for my "V" the day was of to a roll, I am a little behind the clock but all is good as i head for a meeting with OK 7 in Tulsa, We will share a beer in San Antoino JD, thanks for your time Sir. With Oklahoma 9 waiting to meet me in Oklahoma city ...
Trip from Danville to Oklahoma City
We have been on the road for ten days, along the same route we took on our return trip from the East just three months ago. Little did we imagine that we would be back this way so soon. But as most of you already know, with a lot of work and the super-professional help of the Bleier Team our Danville house sold almost instantly after listing and in a few short weeks we were homeless! ...
... been an eye-opening experience for us. We loved the warmth and hospitality of the people here. We loved being Okies from Muskokee., if only for a brief time. OK, maybe the hot weather has gotten to us, but much of the west is suffering through this stifling heat.
Next, having been acclimated to the slower pace of the Midwest, we intend to continue our time here. We are now heading to Wichita, Kansas, where, no doubt, we will have more to share with ...
Somber Day
... anyone who has experienced or endured an act of violence in any shape or form find the strength to continue through life with purpose. They are the Angels that walk amongst us that go unrecognized through their daily lives trying to get past the unforgettable acts!
Good night.....May Peace Come! Amen
... cool, but we didnt have time to go inside, hope we didnt miss too much. Close by was the Pop Soda Ranch http://www.route66.com/40.0.html Literally thousands of bottles of soda with lots of different flavors, there is a restaurant, but again we didn't have time to stop. Last stop of the day was at Totem Pole Park. ...


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The 2015 Reeves/Sievers Founders' Award goes to Rep. Mike SellsSeptember 28, 2015 - Washington House Democrats
Continuing its tradition of recognizing individuals and organizations who are truly helping to improve people's lives, United Way of Snohomish County held its annual Spirit of Snohomish Breakfast event on September 24, where five members of the community were honored for their spirit of giving. Rep. Mike Sells was this year's recipient of the Reeves/Sievers Founders' Award, which is similar to a Lifetime Achievement Award. This is what United Way wrote about Mike: "Reeves/Sievers Founders' Award – Mike Sells Mike … Continue reading
WSU Academic Building Groundbreaking CeremonySeptember 24, 2015 - Washington House Democrats
The Capital Budget (HB 1115) passed by the Legislature this year included $54.6 million for the WSU Academic Building at the Everett University Center to house current and projected degree programs by WSU and its partner institutions. University administrators and legislative leaders, including 38th District Reps. Mike Sells and June Robinson, were at the groundbreaking ceremony held on September 22. The 95,000 square foot building will house classrooms, laboratories, faculty offices, and services for students working toward degrees in STEM … Continue reading
Mukilteo Rep. Peterson's statement to Boeing: Don't send middle-class jobs to ChinaSeptember 17, 2015 - Rep. Strom Peterson
OLYMPIA – Last Friday, The Seattle Times reported that Boeing is "close to reaching a deal with the Chinese government to open a 737 jet completion and delivery center in China." According to a source interviewed by the Times, the details could be announced during the upcoming Seattle visit of Chinese President Xi Jinping. Currently, all 737 jets are assembled, finished and certified in Washington state before delivery to international customers. Under Boeing's new deal with China, 737 airframes ordered … Continue reading
Statement from Seattle area legislators regarding the educators' strikeSeptember 16, 2015 - Washington House Democrats
The following statement is from Representatives Farrell, Pollet, Walkinshaw, Santos, Pettigrew, Tarleton, Carlyle, Ryu, Kagi, Fitzgibbon, and Bergquist, and Senators Frockt, Pederson, Jayapal, Kohl-Welles, Chase, and Hasegawa. "The Seattle educators' strike has highlighted that it is the responsibility of the Washington State Legislature to fully fund education and avert future strikes. If the state had done its job of fully funding education, our kids would already be in school. The lack of funding runs contrary to our core value that public education … Continue reading
Statement from Rep. Cindy Ryu on the fatal shooting by police in PascoSeptember 10, 2015 - Rep. Cindy Ryu
We have a problem in America, and in Washington state, with violence and death. I support the governor's decision to have the state's attorney general review the county prosecutor's decision not to file charges against the three officers who fired the 17 shots that killed Antonio Zambrano-Montes. It's a tragedy when a police officer dies in the line of duty—and just as tragic when people are shot and killed by police. This is happening far too frequently, especially with people … Continue reading
Innovative new building could save taxpayers $880 million dollarsSeptember 8, 2015 - Rep. Hans Dunshee
This video is fun to watch. It's a backhoe taking down a parking garage where the new 1063 building will go up–the future home of the State Patrol headquarters and other state agencies in Olympia. Yet what's happening here isn't just your average construction project. This is something new and innovative. Because that headline is accurate: taxpayers could truly save up to $880 million over the life of this one building.
Brady Walkinshaw joins widow of killed dairy worker outside Darigold to fight for new safety regulationsSeptember 3, 2015 - Rep. Brady Walkinshaw
OLYMPIA – Yesterday Rep. Brady Walkinshaw (D – Seattle) joined Washington dairy workers and their advocates outside Darigold headquarters in Seattle and committed to fight for stronger, smarter workplace safety regulations for Washington dairy farms in the upcoming legislative session. Among the group was Nubia Guajardo, the widow of a man who died during his night shift at a dairy in Mabton, Wash., just south of Yakima. Her late husband, Randy Vasquez, drowned last February when his front-end loader slipped … Continue reading
Statement from House Majority Leader Pat SullivanAugust 31, 2015 - Washington House Democrats
Statement from House Majority Leader Pat Sullivan on Rep. Ross Hunter's appointment as director of the Department of Early Learning: "The House Democratic Caucus has always been a leader in early childhood education, and Ross has been an integral part of our efforts. Anyone who has worked with Ross knows he's a fierce and capable advocate for what he believes in. We will definitely miss his budget expertise and insight, but this is good news for the young children of … Continue reading
Good news for higher education in Washington stateAugust 31, 2015 - Rep. Steve Bergquist
Cutting tuition for all students Years ago, college students worked every summer to save up for that year's tuition. You can't do that anymore. Your average college student could work a full-time job, all year, and not have enough to cover tuition, room and board. This is why most students who drop out of college before getting their degree aren't failing academically. They're struggling financially. It doesn't have to be this way. Our state's economy runs on brainpower and depends … Continue reading
Stakes too high to delay action on Iran nuclear dealAugust 25, 2015 - Rep. Gael Tarleton
Originally published in the Seattle Times, 8/24/15 AS a former Cold War nuclear intelligence analyst for the Pentagon, I can say with confidence that nuclear proliferation in the Middle East poses a vital threat to U.S. security interests. As leaders in the international community, Americans have a special responsibility to take actions preventing Iran from developing a nuclear weapons program. It is time for some diplomatic solutions to the arc of conflict that extends from the Middle East to South … Continue reading
McCleary Phase IIAugust 20, 2015 - mcvicara
Helping people save for retirementAugust 7, 2015 - Rep. Larry Springer
Watch here as representatives from AARP talk about some of the financial concerns we need to keep in mind as we age and how legislation sponsored by Rep. Springer and Senator Mullet is creating the Small Business Retirement Marketplace to help employees of small businesses save for retirement.
Capital budget goes to the dogs — and that's goodAugust 6, 2015 - Washington House Democrats
SILVERDALE — State Rep. Sherry Appleton visited the Kitsap Humane Society (KHS) this week to present them with a ceremonial check symbolizing a $90,000 state grant for a new puppy room. KHS, now in its second century of operation, is one of the largest and busiest no-kill animal shelters in the western U.S., and the area dedicated to their youngest charges has seen better days. The funds from the recently approved capital budget will help the shelter upgrade its puppy … Continue reading
Wylie takes on new responsibility on economic development and international relationsJuly 29, 2015 - Washington House Democrats
State Representative Sharon Wylie was recently appointed to the Legislative Committee on Economic Development and International Relations (LCEDIR). While this is a new responsibility for Wylie, her more than 25 years of management, government relations and leadership experience in business, non-profit and government make her an ideal fit for this position. "I am excited and looking forward to working on ways to help businesses thrive here at home, while also strengthening trade opportunities to continue placing Washington-made goods in the global … Continue reading
New budgets will bring needed construction projects and jobs to 11th DistrictJuly 13, 2015 - Rep. Steve Bergquist
OLYMPIA—The $3.9 billion state construction budget and $16 billion transportation plan will bring much-needed improvements and jobs to the 11th Legislative District. "I am proud to get funding for the Sunset Neighborhood Park in the Renton highlands, which will be the centerpiece of renovation for this area," Sen. Bob Hasegawa, D-Beacon Hill, said. "I am also pleased that we were able to secure over a billion dollars to ensure long overdue work is completed for I-405 though Renton and the … Continue reading
Statement by Rep. Kilduff: Governor's signature on new law means hope for veteransJuly 7, 2015 - Rep. Christine Kilduff
There's exciting news for veterans: Gov. Jay Inslee has signed a law protecting your G.I. Bill benefits here in Washington. A glitch in federal laws meant up to 20,000 vets and their families could have lost their funding to get a college degree unless Washington state changed how we legally define "resident student." It's wrong that a technicality could have stopped brave men and women from using a benefit they earned through hard work and sacrifice while serving our country. I'm proud … Continue reading
Kilduff: State budget invests in public schools, cuts college tuitionJuly 2, 2015 - Rep. Christine Kilduff
OLYMPIA—The new state budget puts a record amount of new funding into our public schools and cuts college tuition without raising new taxes. "This is a budget for the people, not the powerful," said Rep. Christine Kilduff (D-University Place). "It's a budget for middle class moms and dads with kids in public schools, for teachers and state employees who've gone year after year without a raise and for every college student struggling to pay the astronomical price of tuition. And … Continue reading
Cleveland, Moeller, Wylie: "Transportation revenue package good for the state, includes projects for 49th LD"July 1, 2015 - Washington House Democrats
The Washington State Legislature passed a 16-year, $16.2 billion transportation revenue package that invests in transportation infrastructure projects across the state through an 11.9 cent gas tax, motor vehicle fees, and bonds. The package is expected to create more than 150,000 jobs. Sen. Annette Cleveland, Rep. Jim Moeller, and Rep. Sharon Wylie, of Vancouver, issued the following statement: "The transportation revenue package that passed today will make critical infrastructure investments and will help improve mobility throughout our state. "The revenue … Continue reading
Gregory bill will put more qualified teachers in Washington classroomsJune 30, 2015 - Washington House Democrats
In the final hours of the final day of the final special session of 2015, Rep. Carol Gregory's bill to expand Washington's cohort of teachers with specialized skills cleared its final hurdle, passing out of the Senate with a solidly bipartisan 37-8 vote. Gregory (D-30th district, Federal Way), a former classroom teacher appointed to fill the House seat vacated by the death of Rep. Roger Freeman, knew coming in that one of the many problems in Washington's public school system … Continue reading
Statement from Rep. Carol Gregory on the operating budgetJune 30, 2015 - Washington House Democrats
"I want to congratulate my colleagues in the Legislature, and Gov. Inslee, for producing a bipartisan, compromise budget that fulfills the state's responsibilities in so many important areas without requiring a general tax increase. "The good things that this budget does for healthcare, for foster children, for persons with mental illness – and their families – are tremendous. As a former educator, of course, I'm pleased to have been able to vote for a budget that includes the largest increase … Continue reading


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Sarah Polley set to write and direct John Green's 'Looking For Alaska'
John Green has become something of a big deal since the opening of "The Fault In Our Stars," and more power to him. I am all for anything that gives power to the writer as opposed to basically anyone else in the food chain. Green sold the rights to this novel to Paramount years ago, and my guess is that as soon as "Fault" opened, they got real excited about what must have been a wildly reasonable investment.
Sarah Polley, writer/director of 'Take This Waltz' and 'Stories We Tell,' and Academy Award-nominated for her screenplay 'Away From Her,' is set to write and direct 'Looking For Alaska.' The book, by 'Fault In Our Stars' author John Green, has been in development for years, but is picking up steam as 'Fault' crosses the $100 million domestic box-office mark.


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you are viewing a single comment's thread.
Hi Charles.
Wrong again dribbler. Let your hate and dribbling be your only friend for another decade won't you? PS: we all thought you were dead. The board was better when you were.
Yes Sybil, you ARE all one poster.P.S. Do you always 5-star rec your own posts? What a loser!ROTFLMAO!!!Sully
Tommy, you are jumping to some faulty conclusions about who is who here. I thought you were smarter than that. It turns out that you may have no more intelligence than the one here who disguises himself as sullys_ebay_board and constantly sings sully's praises. Now there is a topic for brainy discourse. What is the mental pathology of a poster like sullys_ebay_board who would rather waste his time pumping and kissing the butt of a worthless poster like sully than to be working on enjoying and improving his own life. I think it is a combination of very low self esteem and nothing better to do with his time. I also think it is because he knows he has nothing of value to contribute to the board and so he hides behind sully as a way of establishing a safe niche from which he can throw darts at other posters without having to talk to anybody in a more meaningful way which he is obviously incapable of doing.Another interesting topic is why does sully always need to point out the typos of the intelligent posters by saying that their posts make no sense even though any normal person with at least average intelligence can figure them out in spite of the typos. I believe sully does this because he knows that he is not very intelligent himself and so the only way he can feel better about himself in the company of people who are clearly way smarter thsn him is to find some small mistake by which he can try to make himself look smarter than them by trying to make them look foolish. All he succeeds in doing though is showing everyone that he's got serious psycholgical problems.Spike
spike,Excellent analysis of sully's psychopathology. Thanks for that brainy discourse.SEN


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Apopka, FLUSA
Hometown: Apopka
May 7, 2012
I've had various drama classes over the years, including a short class on improv in college.
I hope to have some fun playing improv games and meet some great people.
1. Imagination 2. Comfortable working with give and take/flow of conversation 3. Sense of fun
No introduction yet
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